Membership Application Form

Contact Information

Contact Name

Contact Title

Contact Email

Contact Phone

Contact Cell

Webpage

Membership Type

Where and when was your company incorporated or established?

What is the legal nature of your company?

Please provide two references, including company name (if applicable), contact person, address, telephone, and email address. One reference is sufficient if the reference is a Member of the Association and has a business relationship with your company. For applicants that provide consulting services, references must be from a company with an offset (IRB/ITB/VP) obligation in Canada. Please provide complete contact information for your reference(s).

Reference 1

Company Name

Name

Title

Phone

Reference 2

Company Name

Name

Title

Phone

Reason(s) to join

Why do you wish to join the Association and how did you hear about the Association? If it was through a Member, please list who it was.

Applicant

Agreement List

- I hereby certify that my company had, has or expects to have an IRB/ITB/VP obligation, or is supporting as a consultant a company or companies which have or expect to have an IRB/ITB/VP obligation.

- I hereby certify that if approved to become a Member, I will be bound by and obey the Bylaws of the Industrial Participation Association of Canada (IPAC), including an obligation to pay annual dues to maintain membership in good standing, and comply with the policies applicable to Members, including but not limited to, its Antitrust Policy and Non-Discrimination Policy. Copies of the Bylaws and above referenced policies will be made available upon request. An invoice for annual dues will be sent once membership has been approved by the Executive Committee.

- I hereby certify that the applicant (prime contractor, subcontractor, business entity, or individual) is not included on any denied party and similar lists in its country of formation, and the applicant (and its owners and affiliates) is not listed on any denied party and similar lists maintained by Canada and/or the jurisdiction of the applicant.

- I hereby certify that the company is duly organized and in good standing in its jurisdiction of formation.

- I understand that only employees or partners are entitled to the benefits of membership in the Association, including representation at meetings, conferences, training, etc. Subcontractors, non-affiliated companies and consultants to Members are not permitted to benefits of a membership unless they are Members as well.

Annual IPAC Membership fees cover the period January through December and are invoiced in January of each year, payable upon receipt.

Company Information

Contact Information

Reference 1

Reference 2